Burning HOT: revisiting guidelines associated with home oxygen therapy

Abstract

Burn injuries secondary to home oxygen therapy (HOT) have become increasingly common in recent years, yet several guidelines for HOT and chronic obstructive pulmonary disease (COPD) neglect to stress the dangers of open flames. This retrospective review of burn injury admissions secondary to HOT to our burn centre from 2007 to 2012 aimed to establish the extent of this problem and to discuss the current literature and a selection of national guidelines. Out of six patients (five female, one male) with a median age of 72 (range 58-79), four were related to smoking, and two due to lighting candles. The mean total body surface area (TBSA) affected was 17% (range 2-60%). Five patients sustained facial burns, two suffered from inhalation injury (33.3%), and five required surgery (83.3%). Mean total length of stay was 20 days (range 8 to 33), and one patient died. Although mentioned in the majority, some guidelines fail to address the issue of smoking in light of the associated risk for injury, which in turn might have future implications in litigation related to iatrogenic injuries. Improved HOT guidelines will empower physicians to discourage smoking, and fully consider the risks versus benefits of home oxygen before prescription. With a view on impeding a rising trend of burns secondary to HOT, we suggest revision to national guidelines, where appropriate.

Keywords: Oxygen inhalation therapy; burns; chronic obstructive; guidelines; practice; pulmonary disease; smoking.